In the recent outbreak of novel coronavirus infection worldwide, the risk of thrombosis and bleeding should be concerned. We aimed to observe the dynamic changes of D-dimer levels during disease progression to evaluate their value for thrombosis. In this study, we report the clinical and laboratory results of 57 patients with confirmed COVID-19 pneumonia and 46 patients with confirmed community-acquired bacterial pneumonia (CAP). And their concentrations of D-dimer, infection-related biomarkers, and conventional coagulation were retrospectively analyzed. The Padua prediction score is used to identify patients at high risk for venous thromboembolism (VTE). The results found that, on admission, both in COVID-19 patients and CAP patients, D-dimer levels were significantly increased, and compared with CAP patients, D-dimer levels were higher in COVID-19 patients (P < 0.05). Besides, we found that in COVID-19 patients, D-dimer were related with markers of inflammation, especially with hsCRP (R = 0.426, P < 0.05). However, there was low correlation between VTE score and D-dimer levels (Spearman's R = 0.264, P > 0.05) weakened the role of D-dimer in the prediction of thrombosis. After treatments, D-dimer levels decreased which was synchronous with hsCRP levels in patients with good clinical prognosis, but there were still some patients with anomalous increasing D-dimer levels after therapy. In conclusion, elevated baseline D-dimer levels are associated with inflammation but not with VTE score in COVID-19 patients, suggesting that it is unreasonable to judge whether anticoagulation is needed only according to D-dimer levels. However, the abnormal changes of D-dimer and inflammatory factors suggest that anticoagulant therapy might be needed. Keywords D-dimer • COVID-19 • Bacterial pneumonia • Retrospective analysis Highlights• After COVID-19 outbreaks, the risk of thrombosis and bleeding has attracted much attention. • It has been reported that abnormal D-dimer levels are associated with poor prognosis.• D-dimer levels were higher in COVID-19 patients and were related with markers of inflammation, and after treatments, D-dimer levels decreased which was synchronous with hsCRP levels in patients with good clinical prognosis. Also, the low correlation between Padua VTE score and D-dimer levels weakened the role of D-dimer in the prediction of thrombosis. • The abnormal changes of D-dimer and inflammatory factors suggest that aggressive anticoagulant therapy might be needed.
Bovine pericardium is widely used in surgery and is commonly used for a patch after arteriotomy during cardiovascular surgery. Bovine pericardial patches have several advantages compared to prosthetic patches, including superior biocompatability, easy handling, less suture line bleeding and possibly reduced rates of infection. These advantages of bovine pericardium have led to its common use during carotid endarterectomy. However, long-term clinical results reported after carotid endarterectomy have suggested several issues that may be related to the patch including restenosis, pseudoaneurysm formation, infection, fibrosis, calcification and thrombosis. These complications may diminish the long-term efficacy of carotid endarterectomy and suggest potential areas for improvement of surgical patches. Understanding the mechanisms by which bovine pericardium heals after patch angioplasty may lead to next generation tissue engineered patches.Bovine pericardium (BP) has come into common clinical use during the past 20 years, especially when used as a patch for arterial closure during vascular and cardiac surgery. Bovine pericardial patches possess many technical merits that have led to their widespread adoption in the operating room, including easy handling, less suture bleeding and the ability to immediately perform arterial duplex examination at the site of angioplasty. However, long-term results of this biomaterial are poorly documented and need cautious interpretation as to whether its long term performance is related to the material itself or to the operation in which it is used. For example, it is unclear whether restenosis after carotid endarterectomy is directly related to the patch itself or whether restenosis is an inevitable consequence of the arterial procedure. In addition, there are sporadic reports of unusual complications with BP patches, including patch rupture and cartilaginous metaplasia. Although these reports are Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. unusual, careful examination of these potential areas of improvement may lead to future generations of BP patches with superior performance. NIH Public AccessThe native structure of bovine pericardium has three layers: 1) the serosa, the inner thin layer consisting of mesothelial cells; 2) the fibrosa, the thicker layer formed by diversely oriented, wavy bundles of collagen and elastin; and 3) the epipericardial connective tissue layer, the outer layer that is partly continuous with the pericardiosternal ligaments. Commercially available patches are processed to be acellular, preventing transpl...
Background: Revascularization of the supra-aortic major branches in thoracic endovascular aortic repair (TEVAR) is challenging owing to the complex anatomic configuration of aortic arch pathologies. This study aims to evaluate the feasibility, effectiveness, and safety of three major techniques-chimney, fenestrated, and in-situ fenestration-for patients with aortic arch pathologies. Methods: A retrospective analysis was performed involving 234 patients with aortic arch lesions, who underwent TEVAR with adaptations in technique (chimney, fenestrated, or in-situ fenestration) between January 2016 and December 2017. Results: One hundred and twenty-six patients underwent the chimney technique (98 single chimneys, 24 double chimneys, and four triple chimneys); one hundred and two patients (102/234) were treated with on-the-table fenestration technique (92 single fenestrations, nine double fenestrations, and one double fenestration plus innominate artery chimney); and the remaining six patients underwent in-situ needle fenestration technique. Overall, indications included aortic dissections (99/234), aortic arch aneurysms (60/234), penetrating aortic ulcers (72/234), and re-interventions (3/234). The technical success rates were 99.6%. There were five cases of early all-cause mortality. The patency rates of overall branches were 99.6%.There were 15 cases with type Ia endoleak-14 in the chimney group (11.1%) and one in the on-the-table fenestration group (1%). Five patients underwent re-interventions. The median follow-up time for all patients was 28 (range, 16-41) months. Conclusions: Our experience suggests that chimney, on-the-table fenestration, and in-situ needle fenestration techniques are feasible, effective, and safe treatment options for aortic arch pathologies with encouraging mid-term results. Long-term durability concerns require further evaluation.
Vascular smooth muscle cells (VSMCs) undergo cell biological changes in response to a variety of cytokines and growth factors. Adiponectin inhibits neointimal formation through suppressing the proliferation and migration of VSMCs. However, the mechanisms underlying the effect of adiponectin on VSMC proliferation and apoptosis require further investigation. The present study was designed to investigate the mechanisms of adiponectin on VSMC proliferation and apoptosis, focusing on the mitofusin‑2 (MFN2) mediated Ras‑Raf‑extracellular signal regulated kinase (Erk)1/2 signaling pathway. The results of western blot analysis revealed that adiponectin increased the expression of MFN2 in a concentration‑dependent manner. Adiponectin also suppressed VSMC proliferation and induced VSMC apoptosis. However, transfection of the VSMCs with small interfering (si)RNA, to knock down the expression of MFN2 attenuated the effect of adiponectin on VSMC proliferation and apoptosis. The decreased expression levels of Ras, phosphorlated (p)‑c‑Raf and p‑Erk1/2, observed in the VSMCs treated with adiponectin were also reversed by the transfection of the VSMCs with MFN2 siRNA to knock down the expression of MFN2. The results of the present study demonstrated for the first time, to the best of our knowledge, that adiponectin exhibits an inhibitory effect on VSMC proliferation and induces cell proliferation via regulation of the expression levels of MFN2. Adiponectin upregulated the expression of MFN2, inhibiting the Ras‑Raf‑Erk1/2 signaling pathway, which led to the inhibition of VSMC proliferation and the induction of VSMC apoptosis. The results of the present study may provide a novel basis for the therapy of vascular disease.
Erythromycin has a noticeable effect on the metabolism of quetiapine. When quetiapine is co-administered with CYP3A inhibitors such as erythromycin, the dosing regimen should be modified according to quetiapine TDM.
Vertebrovertebral arteriovenous fistula is an uncommon vascular disease with no clear management guidelines. It is most commonly caused by iatrogenic injury. We have presented the details of two iatrogenic cases and a review to discuss strategies for endovascular and surgical approaches. From the digital subtraction angiography findings, the vertebrovertebral arteriovenous fistulas were occluded by endovascular coil positioning (patient 1) and surgical ligation of the fistulas (patient 2). Although endovascular approaches are increasing in popularity and considered well-tolerated treatments, open surgical treatment is still reserved for the most complex cases and those not feasible for endovascular treatment.
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